不孕症与沙眼衣原体

沙眼衣原体感染是发病率最高的性传播疾病,发病人数逐年增加。因沙眼衣原体感染引起输卵管炎及盆腔炎可致不孕症,预防及早期发现沙眼衣原体感染对减少不孕症的发生意义重大。沙眼衣原体感染症常无任何症状而呈慢性经过。首先引起宫颈管局部充血、水肿、粘液性分泌物增多,分泌物中可见多形核白细胞,此时,自觉症状轻微或无症状。如未治疗,感染可向上蔓延引起子宫内膜炎、输卵管炎、附件炎和盆腔炎。整个过程可无发热、腹痛、带下等症状。 诊断方法:①检测沙眼衣原体抗原:阳性率低,不能诊断宫颈以上部位的感染。但沙眼衣原体抗原阳性者输卵管粘连阻塞导致不孕的可能性很大。检查子宫内膜、输卵管、盆腔内有无感染,需检查沙眼衣原体抗体。②检测沙眼衣原体     

生殖道支原体和衣原体感染与不孕

近年来,国内外研究证实:解脲支原体(UU)和沙眼衣原体(CT)是影响人类生殖道健康的重要病原体之一,生殖道支原体和衣原体感染者是不孕不育的高发人群,它可造成女性输卵管的粘连和阻塞及子宫内膜炎等,导致不孕不育,且与不良孕产结局有较高相关性。1女性生殖道支原体和衣原体感染与不孕的关系女性生殖道支原体感染是导致不孕的重要因素之一。张月莲等[1]的研究指出:无论生殖道哪个部位(包括宫颈,子宫内膜,输卵管等)被UU感染,均可引起输卵管通液障碍,UU阳性组中输卵管通液障碍者占75%,显著高于UU阴性组。对上述患者行腹腔镜检查发现,UU感染…     

输卵管阻塞患者宫颈和输卵管衣原体、支原体的检测分析

目的 研究输卵管阻塞患者输卵管分泌物衣原体(CT)、支原体(UU)阳性率。方法39例经腹腔镜诊断为输卵管阻塞、要求行输卵管再通手术患者为实验组,26例因其他病因行手术治疗、输卵管正常患者为对照组,采用多聚酶链反应技术(PCR) 对实验组和对照组患者宫颈分泌物和输卵管分泌物CT和UU进行检测。结果 实验组宫颈分泌物CT、UU的检出阳性率分别为35.9%(14/39)、38.5% (15/39),输卵管分泌物的CT、UU检出阳性率分别为25.6％(10/39)、5.1％(2/39);与对照组比较,宫颈分泌物CT、UU感染无明显差异P>0.05);输卵管分泌物CT阳性检出率差异有显著性(P<0.05)。实验组CT阳性检出率高于UU检出率,差异有显著性(P<0.05)。39例术中输卵管不同程度增粗、管壁增厚,其中19条输卵管管壁增厚,僵硬,管壁纤维化,管腔消失。结论 宫颈和输卵管是CT、UU感染的好发部位,CT、UU能损害输卵管粘膜,造成输卵管阻塞,引起输卵管性不孕。     

80对不孕症夫妇解脲支原体感染与输卵管阻塞的关系

目的:探讨夫妇双方生殖道解脲支原体(UU)感染与女方输卵管阻塞的关系.方法:采用聚合酶链反应技术(PCR),对80例不孕妇女(不孕组)和63例早孕拟行人工流产术的妇女(对照组)进行UU检测.不孕患者施行同月经周期子宫输卵管造影(HSG),结果按输卵管通畅和输卵管阻塞分组.不孕患者丈夫精液同步进行UU培养及检测,精液常规分析并计数白细胞.结果:不孕组UU感染率(42.5%)明显高于对照组(17.4%).不孕组中夫妇双方UU检测均阳性16例,输卵管通畅4例,输卵管阻塞12例;仅男方阳性11例,输卵管通畅为4例,输卵管阻塞7例;仅女方阳性18例,输卵管通畅为7例,输卵管阻塞为11例;夫妇双方均阴性35例,输卵管通畅27例,输卵管阻塞8例.夫妇任何一方UU检测阳性与输卵管通畅度成负相关.丈夫精液UU检测阳性与妻子输卵管通畅度成负相关.精液UU阳性组白细胞计数升高率显著高于UU阴性组;精液检测UU阳性组精液常规异常检出率(51.9%)明显高于阴性组(28.3%).结论:UU可能是引起输卵管阻塞的病原体之一,不孕症男方精液中UU感染能够导致精液常规异常,并与女方输卵管阻塞密切相关.     

沙眼衣原体与输卵管性不孕症

沙眼衣原体(CT)是近年来主要的性传播性疾病病原体之一，主要引起男女泌尿生殖道感染，导致男女不孕不育症。据WHO报道全球每年约5亿人新发性传播疾病，其中CT感染占18％，近年来，其发病率呈上升趋势，女性发病由1．8％增至3．5％，而男性从2．1％增加至6．6％，而由此引起的输卵管性不孕症(TFI)占总Tn的36％。     

不孕症患者中的砂眼衣原体感染

本文对天津中心妇产科医院不孕门诊中基础体温基线高,有潜在感染现象而无其他症状(经诊刮、精液检查、内分泌测定,输卵管造影、滴虫、霉菌,性交后试验等均正常)的不孕患者32例,作宫颈砂眼衣原体荧光直接法检测,查得阳性11例、阳性率为34.3％,对其中9例用四环素或洁霉素治疗,均获治愈,并3例妊娠。本文对诊断方法与治疗作了讨论,并提出在不孕患者中作砂眼衣原体检查的必要。     

沙眼衣原体感染与输卵管性不孕关系的Meta分析

目的:全面系统地了解沙眼衣原体(CT)感染与输卵管性不孕(TFI)关系的研究现状.方法:检索1998～2008年间以英文形式公开发表的有关CT感染与TFI关系的原始文献,使用Revman 4.2软件进行Meta分析.结果:共纳入原始文献5篇,累积样本量1543例,其中CT阳性496例.经Meta分析得出CT感染与TFI发病合并OR值为4.07,95%CI为3.13～5.28.结论:CT感染与TFI存在相关关系,CT感染是TFI发病的危险因素之一.     

生殖道解脲支原体与沙眼衣原体感染和女性不孕的相关性

目的:了解生殖道解脲支原体(UU)、沙眼衣原体(CT)感染和女性不孕是否存在相关性。方法:选择进行UU、CT检查的158例不孕妇女为研究对象,观察其感染的发生率,根据有无感染情况设置病例组和对照组,对两组间结果进行临床分析。结果:UU、CT感染率分别为45.6%、7.6%,病例组上生殖道炎症及输卵管病变的发生率较对照组显著增高,差异有统计学意义(P<0.05)。结论:UU、CT感染与女性不孕高度相关。     

输卵管性不孕症患者输卵管黏膜解脲支原体DNA的表达

解脲支原体(ureaplasma urealyticum，UU)是泌尿生殖道感染的重要致病因子。有研究表明，炎症所致的输卵管性不孕与生殖道(通常指宫颈)UU感染有关^[1]。然而从正常健康妇女甚至女婴生殖道中均可以分离出高比例的UU^[2,3]；另有研究表明，下生殖道炎症患者与健康对照者生殖道UU的检出率是相等的^[4]；更有人认为，不孕症患者宫颈、阴道UU阳性率与输卵管损伤不相关^[5]。因此，UU的致病性及其致病机制有待深入研究。本研究通过荧光定量PCR方法，检测输卵管性不孕症患者输卵管黏膜UU-DNA的表达，同时检测沙眼衣原体(CT)DNA作为参照，以探讨UU在输卵管性不孕症发病中的作用。     

解脲支原体感染与输卵管性不孕的关系

输卵管性不孕在不孕症中占首位[1] 。 70年代以来 ,性传播疾病 (ＳＴＤ)与输卵管性不孕的关系逐渐被重视。近来的研究表明 ,ＳＴＤ的病原体多为淋病双球菌、衣原体或支原体[2 ] 。前两者与输卵管性不孕关系的报道较多 ,而支原体与输卵管性不孕关系的报道甚少。本研究通过对不孕患者的宫颈分泌物、子宫内膜、腹腔液进行解脲支原体 (ＵＵ) ＤＮＡ检测 ,以探讨生殖道ＵＵ感染与输卵管性不孕的关系。一、资料与方法1.资料来源 :选择本院 1997年 4月至 1997年 9月 ,经腹腔镜及病理学检查除外生殖器结核、子宫内膜异位症所致的不孕患者 5 5例 ,分…     

Immunopathogenesis of chlamydia trachomatis infections in women

OBJECTIVE: To develop a model of pathogenesis by which Chlamydia trachomatis progresses from acute to chronic infection, and finally serious disease (salpingitis, tubal occlusion). DESIGN: Review of current literature located through web-based Medline searches using key words: Chlamydia trachomatis, immunology, cytokines, heat shock protein, infertility. RESULT(S): Cell-mediated immune mechanisms appear to be critical in determining whether acute infection is resolved or progresses into chronicity with pathological outcome. What determines the particular immune pathway depends on a range of determinants-HLA subtype and human genetics, cytokine profile, infectious load, route of infection, and endocrinology. A clearer picture of the natural history of chlamydial pathology may assist in providing better predictors of those women who may go on to develop significant sequelae after infection. CONCLUSION(S): Predicting those who may develop serious disease, including infertility, may contribute to improved management of such persons during earlier stages of infection and assist in prevention.     

盆腔粘连与沙眼衣原体和解脲支原体感染的关系

目的　探讨沙眼衣原体 (chlamydiatrachomatis,CT)和解脲支原体 (ureaplasmaurealyticum ,UU)感染与盆腔粘连的关系及其发病机制 ,并试图找到预防和降低盆腔粘连发生的方法和途径。方法　分别采用聚合酶链反应 (PCR)技术、金标免疫斑点法 ,将 5 0例妇科既往无盆腔手术史 ,行腹腔镜和开腹手术中有盆腔粘连患者作为盆腔粘连组 (观察组 ) ,4 0例同期妇科腹腔镜和开腹手术中无盆腔粘连患者为对照组。测定宫颈分泌物和手术标本中的CTDNA、UUDNA ,以及两组患者血清中抗CT和UU抗体。结果　观察组宫颈分泌物CT和UUDNA阳性率分别为 32 %和 4 0 % ;血清CT和UU抗体阳性率分别为 34%和 4 8% ;手术标本CT和UUDNA阳性率分别为 2 6 %和 30 %。对照组宫颈分泌物CT和UUDNA阳性率分别为 7 5 %和 1% ;血清CT和UU抗体阳性率分别为 5 %和 10 2 5 % ;手术标本CT和UUDNA阳性率分别为 2 5 %和 5 %。两组比较差异有显著性 (P <0 0 1)。结论　沙眼衣原体、解脲支原体感染与盆腔粘连有着密切关系。     

泌尿生殖道感染患者淋病奈瑟菌、沙眼衣原体和解脲脲原体感染临床分析

目的了解泌尿生殖道感染患者淋病奈瑟菌（NG）、沙眼衣原体（CT）和解脲脲原体（UU）的感染现状及其特点。方法应用实时荧光聚合酶链反应（PCR）检测630例（男性274例,女性356例）泌尿生殖道感染患者泌尿生殖道分泌物的NG、CT和UU核酸,并对其中108例患者行单纯疱疹病毒（HSV）检测,82例行人乳头瘤病毒（HPV6/11/16/18）检测。结果在630例患者中,NG、CT和UU的阳性检出率分别为3.2%（20/630）、9.8%（62/630）和47.1%（297/630）,HSV的阳性检出率为2.8%（3/108）,HPV6/11/16/18的阳性检出率为8.7%（8/92）,其中男性NG、CT和UU的阳性检出率分别为5.1%（14/274）、10.9%（30/274）和21.5%（59/274）,女性分别为1.7%（6/356）、9.0%（32/356）和66.9%（238/356）,女性UU阳性检出率明显高于男性（P〈0.01）,男性NG阳性检出率明显高于女性（P〈0.05）;男性和女性患者中,NG阳性检出率均以〈30岁组（7.4%,7/94;3.5%,4/115）较高,男性CT阳性检出率以〉40岁组（17.5%,7/40）最高,女性以〈30岁组（17.3%,18/104）最高,UU在不同性别各年龄组比较,差异均无统计学意义（P〉0.05）;CT＋UU双重感染的阳性检出率最高,为8.2%（31/379）,NG＋UU＋CT双重感染检出率为1.6%（6/379）,HPV 6/11＋NG、HPV 6/11＋CT混合感染各1例,HSV-Ⅰ/Ⅱ伴UU感染2例。结论泌尿生殖道感染患者NG、CT和UU阳性检出率不尽相同,其中以UU最高,且女性阳性检出率高于男性,两种及以上病原体混合感染较为常见,临床应注意进行多种病原体的检测。     

A comparative analysis of arterial blood flow in unexplained infertility,tubal infertility and fertile groups

We aimed to compare ovarian (O), uterine (U) and spiral (S) artery (A) resistance of patients diagnosed as fertile, unexplained infertility (UI) and tubal factor infertility (TFI) in the peri-implantation period and independent from the impact of the treatment. UI (n?=?70), TFI (n?=?75) and fertile (n?=?72) patients’ ovarian, uterine and spiral artery pulsatility index (PI), resistance index (RI) and the endometrial thickness, serum estradiol and progesterone levels were compared. The specificity and sensitivity values were calculated according to determined cutoff values. Both TFI and control groups’ UA PI values were significantly lower than the UI group’s PI values. The highest UA RI values were found in UI group and the lowest values were in the control group. UI and TFI groups’ OA PI/RI values were significantly higher than the control group. Both the control and TFI groups’ SA PI/RI values were significantly lower than UI group’s PI/RI values. UI patients’ uterine and spiral arteries PI values >1.86 and >0.85, RI values >0.80 and >0.53 can be used as a valuable test showing reduced uterine perfusion. Ovarian artery PI values >0.96 and RI values >0.58 can be used as tests showing decreased ovarian perfusion in patients with TFI. In these patients, embryo cryopreservation can be considered.     

Decision for disclosure: The experiences of Iranian infertile couples undergoing assisted reproductive donation procedures

Controversy surrounding disclosure among the recipients of assisted reproductive donation procedures is escalating worldwide, but little research has been conducted in this topic. The purpose of this qualitative study was to explore the experiences of infertile couples undergoing assisted reproductive donation procedures. In this exploratory qualitative study, 32 patients (nine couples and 14 women) who were candidates to use donor eggs, donor embryos or surrogacy, and 5 members of infertility treatment team including gynaecologists, midwives and psychologist (total 37) were purposively selected from the Montaserieh Infertility Research Centre at Mashhad, Iran in 2012 and interviewed using a semi-structured in-depth method. Data were analysed using conventional qualitative content analysis with MAXqda software. One overarching theme, entitled ‘experiencing uncertainty surrounding the disclosure to others’ was identified from the data. This theme contained two subthemes including ‘Couples’ decisions to not disclose to others’ and ‘Couples’ decisions to disclose to others’. Five categories formed the first subtheme, and the second subtheme emerged from four categories which are discussed in this paper. The main reason for secrecy was concern over societal negative views about assisted reproductive donation procedures. This worry deprived the couples from support from family and friends and as a result requires them to tolerate psychological pressure when using such procedures.     

Association of Chlamydia trachomatis serology with tubal infertility in Nigerian women

AIM: To determine the association between tubal infertility and Chlamydia trachomatis in Nigerian women. METHODS: This case-control study is from the Departments of Obstetrics and Gynecology of two tertiary hospitals in Nigeria. One hundred and sixty-two infertile patients with tubal occlusion had 162 pregnant women matched for age as controls. Information on sociodemographic variables, sexual and reproductive risk factors, and history of previous pelvic infections were elicited using a study protocol. The prevalence of Chlamydia Trachomatis antibody was determined for cases and controls. RESULTS: The prevalence of serum Chlamydia antibody was significantly higher in cases (65.8%) compared with controls (17.3%; P < 001). The effects of Chlamydia antibodies on infertility were strengthened in the multivariate model controlling for Chlamydia antibodies and gynecologic symptoms, compared to the univariate model. However, the association was attenuated and non-significant when the effects of gynecologic symptoms, sociodemographic characteristics, contraceptive and sexual history were controlled in the conditional logistic regression model. The strongest independent predictors of infertility in the model were vaginal discharge, education less than tertiary and more than three lifetime sexual partners (proxies of sexually transmitted infections). CONCLUSIONS: There was no strong independent association between Chlamydia antibodies and the risk of being infertile in Nigerian women. By contrast, the proxies of sexually transmitted infections were significant predictors of infertility in the women. Efforts to address these factors, which are proxies of sexually transmissible infections, Chlamydia infection, and health-seeking behavior for these infections, will likely contribute to reducing the burden of infertility in Nigerian women.     

输卵管妊娠患者生殖道巨细胞病毒和沙眼衣原体的测定

目的：探讨巨细胞病毒和沙眼衣原体感染与输卵管妊娠的关系。方法：应用酶联合免疫吸附试验法检测95例输卵管妊娠患者（异妊娠组）和42例际件切除术,无输卵管妊娠史的卵巢囊肿患者（对照组）血清中抗巨细胞病毒IgM,应用聚合酶链反应技术测定生殖道组织中巨细胞病毒gH基因和沙眼衣原体热休克蛋白基因。结果：异位妊娠组抗巨细胞病毒IgM阳性14例,阳性率为15％,对照组阳性1例,巨细胞病毒gH基因阳性18例,阳性率为19％,对照组则2例阳性,两组比较差异有差异性（P＜0．05）。异位妊娠组沙眼衣原体热休克蛋白基因阳性25例,阳性率为26例,对照组则阳性2例,两组比较,差异有显著性（P＜0．05）。结论：巨细胞病毒和沙眼衣原体感染可能与输卵管妊娠的发生有关。